Clinical Simulation in Nursing (2014) 10, e241-e247

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Featured Article

Simulation-Based Interprofessional Education

Guided by Kolb’s Experiential Learning Theory
Julie A. Poore, MSN, RNa,*, Deborah L. Cullen, EdDb, Gina L. Schaar, DNP, RNc
a
Clinical Assistant Professor, Department of Community and Health Systems, Indiana University School of Nursing,
Indianapolis, IN 46202, USA
b
Professor, Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN 46202, USA
c
Assistant Professor of Nursing, College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN
47712, USA

KEYWORDS Abstract: Communication and collaboration skill mastery is as essential to nursing practice as exper-
prelicensure nursing; tise in clinical skills. Health profession graduates often lack the necessary communication skills to
nurse education; practice in a collaborative environment because they have been educated in silos with little or no inter-
interprofessional action with other health profession students. Prelicensure interprofessional education has been sug-
education; gested as a strategy for improving communication and collaboration among health profession
simulation; students. Kolb’s Experiential Learning Theory can be used to guide simulation-based interprofessional
communication; education, offering both a foundation and process for knowledge acquisition based on the needs of each
collaboration; individual learner.
health professional
team training; Cite this article:
KOLB; Poore, J. A., Cullen, D. L., & Schaar, G. L. (2014, May). Simulation-based interprofessional education
experiential learning guided by kolb’s experiential learning theory. Clinical Simulation in Nursing, 10(5), e241-e247. http://
dx.doi.org/10.1016/j.ecns.2014.01.004.

Ó 2014 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier
Inc. All rights reserved.

Proficiency in communication and collaboration skills is communication between patients and health professionals
as essential to nursing practice as expertise in clinical skills (United States Department of Health & Human Services
(American Association of Critical-Care Nurses, 2005). The (HHS), n.d.). Consequently, it is critical to optimize
Joint Commission (2012) identified ineffective communica- communication and collaboration among health profes-
tion among health care professionals as a root cause of sionals to improve safety and patient outcomes.
sentinel events in hospitals from 2004 to 2012. In addition, On graduation, nursing students are expected to practice
Denham et al. (2008) asserted that lack of communication collaboratively with physicians and other health care pro-
is a leading cause of preventable errors, which can lead fessionals using effective communication skills to provide
to patient injury or death. Delays in medical treatment safe quality patient care (Robinson, Gorman, Slimmer, and
and inaccurate diagnosis can result from poor Yudkowsky, 2010). Yet, not all nursing students experience
collaborative learning experiences. Therefore, prelicensure
No funding sources or granting agencies supported this work. This education may be the opportune time to begin building
article discusses how Kolb’s Experiential Learning Theory can be used
the foundation for the development of collaborative rela-
to guide simulation-based interprofessional education.
* Corresponding author: japoore@iupui.edu (J. A. Poore). tionships among health professionals.

1876-1399/$ - see front matter Ó 2014 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.ecns.2014.01.004
Simulation-Based Interprofessional Education e242

Health profession graduates often lack the necessary affordable (AHA, 2010). As health care changes, health
communication skills to practice in a collaborative envi- profession education must change to meet practice de-
ronment because they have been educated in silos with little mands. Modifying the current health profession education
or no interaction with other members of the health care from the historic ‘‘silo’’ method to IPE will not only
team. Educating students in silos often results in confusion enhance communication and collaboration but also can
related to the roles and the eventually result in improved patient outcomes (Heuer
contributions each health et al., 2010; Olenick et al., 2010; Wilcock et al, 2009).
Key Points professional offers in the Support for IPE is growing among health profession

Effective communica- practice setting (Dumont, organizations, government departments, and international
tion and collaboration Briere, Morin, Houle, & groups prompting increased interest in IPE (American
are essential compo- Iioko-Fundi, 2010; Thomp- Association of Colleges of Nursing [AACN], 2008;
nents of nursing son & Tilden, 2009). Con- Canadian Interprofessional Health Collaborative [CIHC],
practice. trasting the silo effect, the 2007; IOM, 2001, 2003, 2010; NLN, 2012). The IOM

Simulation based IPE literature identifies interpro- (2010) report asserts that integrating IPE in prelicensure
can be an effective fessional education (IPE) as health care programs is necessary to better prepare health
teaching strategy for a strategy to enhance profession graduates for practice. In addition, the Essentials
improving communi- collaboration and communi- of Baccalaureate Education for Professional Nursing
cation and collabora- cation (Heuer, Geisler, Practice clearly states that interprofessional communica-
tion among health Kamienski, Langevin, & tion and collaboration are critical for improving patient out-
profession students. O’Sullivan-Maillet, 2010; comes (AACN, 2012). Therefore, IPE should be included in

The greater number Institute of Medicine all baccalaureate nursing curricula (AACN, 2008).
of IPE activities stu- [IOM], 2001, 2003, 2010; The purpose of this article is to present the integration
dents participate in, National League for of Kolb’s Experiential Learning Theory (ELT) with
the greater progress Nursing [NLN], 2012; simulation-based IPE to improve communication and collab-
they make in skill Schmitt, Blue, oration among health profession students. First, authors pre-
development related Aschenbrener & Viggiano, sent a critical appraisal of the literature on IPE defining gaps of
to communication 2011; Wilcock, Janes, & knowledge. Second, the article explains the theoretical
and collaboration. Chambers 2009). IPE offers foundation for Kolb’s ELT. Third, a discussion on how Kolb’s
an opportunity for students ELT will provide the theoretical framework for simulation-
to actively engage in deliberate activities that heighten un- based IPE is presented. Last, the implications simulation-
derstanding of professional roles, increase experience of based IPE will have on nursing practice are discussed.
working in teams, and facilitate learning with, from, and
about each other (Heuer et al., 2010). ‘‘IPE occurs when
two or more members of a health team (who participate Literature Review
in either patient assessment and/or management) learn
with, from, and about each other as they collaboratively Table 1 identifies the databases and search terms used in the
focus on patient-centered care and achieving optimal health literature review of IPE. To ensure the literature reflected
outcomes’’(Olenick, Allen, & Smego, 2010, p. 80). current knowledge, publication dates were limited from
Although the literature has suggested and recommended 2007 to present; the only exception was literature that
IPE for many years, few universities have included IPE in focused on the historical development and use of Kolb’s
their curriculums (NLN, 2012). Barriers include low faculty ELT. Additional articles included in this review reflect the
buy-in, schedule limitations, and professional autonomy. application of IPE, the theoretical underpinnings of IPE,
As health care environments evolve, socioeconomic and the outcomes of IPE as related to health care.
pressures, patient outcomes, and well-documented work- Although the literature discusses IPE out of health care, for
force shortages are shifting health care priorities. Prelicen- the purpose of this article, all IPE definitions are within the
sure health care programs must produce graduates capable context of health care. The most widely accepted definition of
of meeting the needs of an evolving health care market. The IPE is from the Centre for the Advancement of Interprofes-
2010 environmental scan performed by the American sional Education (CAIPE, 2002). Table 2 illustrates definitions
Hospital Association (AHA, 2010) identified key issues of IPE found within the literature search. The Centre for the
and emerging trends that will affect the future of health Advancement of Interprofessional Education definition is the
care. Common themes noted in the American Hospital As- foundation from which most other definitions were derived.
sociation report included the need for new delivery models Several studies support the use of IPE to improve
that require collaborative teams which can improve patient communication and collaboration among health profes-
outcomes, increased communication skills among providers sionals and health profession students. Messmer (2008)
to offer more safe and effective care, and increased produc- found that collaboration was best achieved when residents
tivity to meet consumer demands and keep health care costs and nurses jointly participated in multiple simulations.

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The majority of the literature regarding IPE focuses

Table 1 Literature Review of Interprofessional Education
primarily on nursing and medicine. Titzer, Swenty, and
Databases Searched Search Terms Hoehn (2012), however, found that IPE using online case
Cumulative Index Interprofessional education studies was an effective method of improving communica-
to Nursing and tion and collaboration among nursing and radiology stu-
Allied Health dents. Forte and Fowler (2009) focused their IPE study
Literature on occupational therapy, diagnostic radiography, and thera-
Medline Interprofessional learning peutic radiography students. In Forte and Fowler’s study,
Education Resource Simulation
students working on an interprofessional health care unit
Information Center
reported an increased understanding of professional roles
Ovid Interprofessional education
AND simulation and improved communication between professional groups.
Proquest Central Interprofessional education Although IPE has been consistently defined and sup-
AND communication ported in the literature as an effective method of improving
Interprofessional education communication and collaboration among nursing, medical,
AND collaboration radiology, and pharmacy students, the challenge of how
Interprofessional education best to implement IPE remains. The literature is unclear on
AND theoretical framework which teaching strategies best facilitate IPE. Thompson and
Adult learning theory Tilden (2009) piloted four interprofessional initiatives
Kolb’s Experiential Learning including an interactive IPE day, interprofessional service
Theory
learning project, interprofessional simulation, and clinical
Interprofessional education
teaching focused on interprofessional teams. Each initiative
AND nursing theory
Interprofessional education was reported to be successful with no indication that one
AND Kolb’s Experiential was more effective than another. Much like Thompson
Learning Theory and Tilden (2009), Hobgood et al. (2010) piloted four
methods of IPE delivery, among nursing and medical stu-
dents, including high-fidelity simulation, role play, audi-
Baker et al. (2008) utilized simulation-based IPE to height- ence response system coupled with didactic lecture, and
en understanding of professional roles among nursing stu- didactic lecture alone. Students participating in the lecture
dents, medical students, and residents. Feedback from using audience response systems were shown videotaped
their participants identified IPE as an essential component scenarios from TeamSTEPPS (http://teamstepps.ahrq.gov/)
of professional development (Baker et al., 2008). Dillon, that focused on teamwork skills. Students were asked ques-
Noble, and Kaplan (2009) found simulation-based IPE to tions about the scenarios using an audience response system.
be an effective method for improving nursing and medical These responses provided the topics for group discussions.
students’ communication and collaboration. Meffe, Students participating in the lecture only group were given
Moravac, and Espin (2012) developed a pilot IPE program the same lecture and shown the same TeamSTEPPS video
on a hospital obstetrics unit including nursing, midwifery, as the group using audience response system. The lecturer
and medical students to promote collaborative professional answered any questions students had related to the material
practice. Results from this pilot program suggest that IPE in presented but did not initiate or facilitate any additional dis-
prelicensure health education programs could be an effec- cussion. Students’ attitudes toward teamwork improved
tive method of cultivating collaborative behaviors among significantly from preepost test in each of the four pedagog-
health profession students (Meffe et al., 2012). ical methods.

Table 2 Definitions of Interprofessional Education (IPE)

Definition Author (year)
IPE occurs when two or more professions learn with, from, and about each other to improve Centre for the Advancement of
collaboration and the quality of care. Interprofessional Education (2002)
Through interdisciplinary education, health care professionals learn collaboratively within Canadian Interprofessional Health
and across their disciplines to gain the knowledge, skills, and values required to work with Collaborative (2007)
other health care professionals.
IPE occurs when two or more professions learn about, from, and with each other to enable World Health Organization (2010)
effective collaboration and improve health outcomes.
IPE occurs when two or more members of a health team (who participate in either patient Olenick, Allen, and Smego (2010)
assessment and/or management) learn with, from, and about each other as they
collaboratively focus on patient-centered care and achieving optimal health outcomes.

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The literature also identified several theories used to

Table 3 Kolb’s Learning Styles
guide IPE. In several articles, Knowles’ (1990) Adult
Learning Theory has been cited as a possible theoretical Learning
framework for IPE (Barr, 2013; Kaakinen & Arwood, Styles Learner Preferences
2009; Sargeant, 2009). In adult learning theory, learning Diverging
Learn best through concrete
outcomes and goals are directed by the learner (Kaakinen learner experience and reflective observation
& Arwood, 2009). Common principles of adult learning
Learners prefer to work in groups and
theory and IPE include cooperation, collaboration, and participate in generating ideas
Assimilating
Learn best through reflective
reflection (Barr, 2013). Although adult learning theory sup-
learner observation and abstract
ports some of the principles of IPE, the responsibility for
conceptualization
learning in IPE is shared among all members of the group,
Learners are most interested in abstract
not the individual learner (Barr, 2013). concepts and have the ability to put
Benner’s novice to expert model has also been used as a information into a concise logical format
framework for IPE studies (Titzer et al., 2012). As learners gain Converging
Learn best through abstract
experience, they move in stages from novice to expert (Titzer learner conceptualization and active
et al., 2012). Using Benner’s theory, students would gain expe- experimentation
rience through IPE that moves them through the stages of
Learners are problem solvers who prefer
novice to expert in their respective fields. However, Benner’s technical tasks to social issues
model does not account for the process by which learning oc- Accommodating
Learn best through concrete
learner experience and active experimentation
curs in the IPE experience. Benner’s model does not address in-

Learners prefer hands-on experience
dividual learning styles or differentiate how learning is
acquired during the simulation, debriefing, and reflective Source: Kolb (1984).
phases. Conversely, Kolb addresses individual learning styles
and presents a cyclical process that allows learners to acquire
knowledge during each phase of the learning cycle. work on the experiential component of learning. Dewey
stressed the significance of learning through experience,
rather than textbooks and teachers (Kolb, 1984). Much of
Theoretical Foundation Lewin’s work focused on integrating theory into practice
(Kolb, 1984). Piaget’s work focused on how cognitive
Kolb’s ELT defines learning as ‘‘the process whereby development is influenced by experience (Kolb, 1984). In
knowledge is created through the transformation of expe- developing the ELT, Kolb created a model of learning
rience. Knowledge results from the combination of that emphasized the role experience plays in the learning
grasping and transforming experience’’ (Kolb, 1984, process (Kolb, 1984). Kolb did not want to offer the ELT
p. 41). The learning cycle, created by Kolb, consists of as a replacement or alternative for cognitive and behavioral
four phases that include (a) concrete experience where theories but sought to present ELT as ‘‘an integrative
the learner participates in an experience such as a simula- perspective on learning that combines experience, percep-
tion, (b) reflective observation where the learner reflects tion, cognition, and behavior’’ (Kolb, 1984, p. 21).
on the experience, (c) abstract conceptualization where Walker and Avant (2011) assert that middle-range the-
the learner considers thoughts and reflections to identify ories are testable but general. Kolb’s ELT is testable and
the significance of the learning experience and considers general, therefore consistent with most aspects of a
what may have been done differently to enhance the middle-range theory (Lisko & O’Dell, 2010). Broad in
outcome, and (d) active experimentation which involves us- scope, Kolb’s ELT has been utilized as an approach to
ing what was learned to direct future practice. learning in multiple disciplines such as nursing, business,
In addition to providing a process for experiential geography, and education (Baker et al., 2008; Healey &
learning, Kolb recognized the importance of individual Jenkins, 2000; Lisko & O’Dell, 2010).
learning styles as well as an opportunity for each learner The six propositions of Kolb’s ELT, found in Table 4,
to acquire knowledge, based on their individual preferences when combined with Kolb’s learning cycle generate knowl-
(Kolb & Kolb, 2009). The four learning styles and individual edge through the transformation of experience (Kolb &
preferences are presented in Table 3. Learners must experi- Kolb, 2009). Kolb’s theory offers both a foundation and
ence each phase of Kolb’s cycle to achieve optimal learning. process for knowledge acquisition based on the needs of
However, learners do not always use all phases equally, usu- each individual learner. The schematic depiction of Kolb’s
ally showing a preference for one or two phases based on ELT (Figure 1) identifies the learning cycle, learning styles,
their individual learning styles (Lisko & O’Dell, 2010). and phases of the learning cycle that best accommodate the
The foundation for Kolb’s theory was based on the work learning styles of each individual learner. The first assump-
of Dewey, Lewin, and Piaget (as cited in Kolb, 1984). tion of Kolb’s ELT is that people adapt and change. Expe-
Dewey, Lewin, and Piaget each focused much of their riential learning offers students a method for developing

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Table 4 Propositions of Kolb’s Experiential Learning Theory

Learning is a process Engaging students in an active experience enriches their learning.
All learning is relearning Relearning is best expedited using a process that offers students the opportunity to
examine their beliefs and ideas and integrate them with new ideas that are more
advanced.
Learning is a dialectic process Students shift between the varying modes of reflection, action, feeling, and thinking.
Learning is holistic and integrative Learning takes into account the whole person, including how they think, feel, perceive,
and behave when solving problems and making decisions.
Learning results from interactions between Learners process the possibilities of an experience based on their lived experience.
person and environment
Learning is the process of creating Social knowledge is generated based on personal knowledge of the student.
knowledge
Source: Kolb (1984).

and adapting their knowledge, skills, and attitudes. The session. Each learner brings life experience to the simula-
knowledge, skills, and attitudes that students develop tion that will affect how this individual processes and
through the ELT can guide change within their individual employs the knowledge they gain through the experiential
practice. The second assumption is that learning is a learning cycle (Kolb, 1984).
continually recurring cycle; each time a learner completes Using Kolb’s model, simulation represents the concrete
Kolb’s learning cycle, learning occurs at a higher more experience of learners. Reflective observation occurs during
complex level (Davies & Gidman, 2011). Completion of and after the simulation debriefing phase. Kolb’s phase of
one cycle of Kolb’s ELT leads to another set of experiences, abstract conceptualization allows learners to consider the
thus another cycle of learning. relevance of the IPE experience, stimulates new ideas, and
offers learners an opportunity to consider if anything should
have been done differently during the simulation (Morse,
Operationalizing Kolb’s Experiential Learning 2012). During the active experimentation phase, learners
Theory for Simulation-Based Interprofes- test what was learned by applying knowledge to new situ-
ations such as additional simulations, clinical experiences,
sional Education
or work experiences (Morse, 2012). Kolb’s ELT also ex-
plains how individualized learning is achieved through
Kolb asserted that learning is a process. Simulation
four learning styles within the phases of the learning cycle.
represents an IPE instructional design that can be employed
Regardless of the preferred learning style of each individual
to improve communication and collaboration among health
student, Kolb’s model offers a process to facilitate learning
profession students. During the simulation and debriefing,
through application of the preferred style. The more oppor-
students have the opportunity to interact with one another
tunities nursing, medical, and respiratory therapy students
and the environment while examining their beliefs and
have to engage in IPE activities the better their communi-
ideas. Learning not only takes place during the simulation
cation and collaboration skills once they begin professional
activity, but it also occurs during reflection in a debriefing
practice (AACN, 2008; CIHC, 2007; IOM, 2001, 2003,
2010; NLN, 2012).
IPE is a key strategy for improving communication and
collaboration among health professionals (Heuer et al., 2010;
IOM, 2001, 2003, 2010; NLN, 2012; Schmitt et al., 2011;
Wilcock et al., 2009). Simulation is one method that can be
employed to guide IPE among students from varying health
professions, ultimately leading to improved communication
and collaboration skills. Notably, the HHS (n.d.) asserted
that effective communication among health professionals
enhanced their ability to provide safe and effective care.
These ideas foster a synergy among IPE, communication,
collaboration, and simulation, which should be explored.
The conceptual relationship of IPE to the improvement of
Figure 1 Kolb’s Experiential Learning Theory. Adapted from:
KOLB, DAVID A., EXPERIENTIAL LEARNING: EXPERI- communication and collaboration by using simulation-based
ENCE AS A SOURCE OF LEARNING & DEVELOPMENT, IPE among health professionals can be viewed as a cyclical
1st,Ó1984. Printed and Electronically reproduced by permission process. Figure 2 depicts a theoretical model of how Kolb’s
of Pearson Education, Inc., Upper Saddle River, New Jersey. ELT can be used to guide simulation-based IPE. Kolb’s ELT

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explains the process of knowledge creation through the Implications for Nursing
transformation of experience (Kolb, 1984) using
simulation-based IPE. The greater number of IPE activities IPE can play an integral role in shaping nursing education.
students participate in, the greater progress they make in skill Future health care delivery will require coordinated efforts
development related to communication and collaboration. among all professions to efficiently and effectively manage
Evaluative structures aid in supporting Kolb’s ELT as a patient populations (Heller, Oros, & Durney-Crowley,
theoretical framework to guide simulation-based IPE. The 2011; IOM, 2001, 2003, 2010; NLN, 2012). IPE facilitates
concept of IPE focuses on ‘‘health care professionals learning teamwork and collaboration among health care profes-
collaboratively within and across their disciplines to gain the sionals, which can ultimately lead to increased patient
knowledge, skills, and values required to work with other safety, better quality of care, and improved patient out-
health care professionals’’ (CIHC, 2007, p. 6). The internal comes (Olenick et al., 2010; Suter, Arndt, Arthur,
consistency among the concepts of concrete experience, Parboosingh, & Deutschlander, 2009). Barriers to IPE
reflective observation, abstract conceptualization, and active continue to challenge all. Entrenchment, dismissive atti-
experimentation within Kolb’s ELT is clear. The concepts tudes, poor role models, and lack of incentives will need
are consistently used and clearly defined within Kolb’s ELT; to be addressed to promote collaboration.
thus, they exhibit internal consistency. There is a logical Several studies revealed the success of IPE; yet, few
congruence within Kolb’s model which is demonstrated by focused on utilizing simulation among health profession
the way learners move through the phases: concrete experi- students. Furthermore, most studies utilizing students focused
ence, to reflective observation, to abstract conceptualization, primarily on nursing and medicine (Baker et al., 2008; Dillon
and finally to the active experimentation phase. et al., 2009; Meffe et al., 2012; Titzer et al., 2012), which con-
Kolb’s ELT was assessed for operational adequacy and firms a gap in the literature. Adding respiratory therapy and
pragmatic utility in relation to IPE. Kolb’s ELT is testable, other health profession students to simulation-based IPE will
is one of the most widely used learning theories, and has add to the complement of nursing and medical students,
been operationalized at the individual, group, organiza- increasing the body of knowledge of IPE.
tional, societal, and global level (Kolb & Kolb, 2009). Case Experiential learning is fundamental to preparing
Western Reserve University (2010) has integrated Kolb’s nursing students for professional practice. Although the
ELT, with the Institute for Healthcare Improvement Model majority of nursing education has occurred in silos, Kolb’s
and the Framework for Action on Collaborative Practice as ELT offers both a process for delivering IPE and a
a foundation for their IPE center. The ELT has wide- mechanism to maximize the learning of each individual
ranging applicability and has been used in management, ed- student. Success for carrying out simulation-based IPE has
ucation, information science, psychology, medicine, significant implications for large-scale incorporation of IPE
nursing, accounting, and law (Kolb & Kolb, 2009). being implemented within a large Midwestern university’s
baccalaureate curriculum. Operationalization of IPE using
Kolb’s ELT can provide strategies for effective design,
development, and implementation of future IPE simulation
experiences. IPE will change the way nurses teach, learn,
and practice with the goal of facilitating enhanced commu-
nication and collaboration, ultimately leading to improved
patient outcomes (Heller et al., 2011).

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Clinical Simulation in Nursing
Volume 10
Issue 5